One in four adult women has experienced at least one physical assault from a partner during adulthood, and one incident of domestic violence is reported to the police every minute. The findings of a study recently presented to frontline workers shows there are still many barriers to women seeking help for themselves and their children. It is not simply a case, as some would argue, of "she just won't leave him".

The lottery funded a three-year study, Domestic Abuse: Women Seeking Help (Dash), a collaboration between Sheffield University and the Sheffield Domestic Abuse Forum, a multi-agency partnership to combat domestic abuse.

The results of a population survey from the study confirmed a wide-ranging ignorance of the extent and commonplace aspect of domestic violence. A questionnaire was sent to 3,050 people in Sheffield, roughly half of which were men and half were women. Of these, 1,340 valid questionnaires were returned - a 41% response rate. Some 60% were from women.

Only 17% of the respondents were aware of the one in four statistic outlined above. Most believed that the proportion of women that had experienced domestic violence was one in every 25. The majority of men and women considered that "punching", "sex without consent", "slapping", "threats of violence" and "verbal aggression" represented acts of domestic violence, and more than half identified "controlling social life" in the same way.

However, women were significantly more likely than men to see "sex without consent", "verbal aggression" and "controlling social life" as abuse. Most respondents believed that drugs and alcohol abuse were a major cause of male violence, and significantly more women than men believed that men were violent in order "to be in control". However, 20% of all respondents believed that women "provoke" male violence.

The survey respondents placed domestic violence seventh in a list of eight crimes that threaten public safety, behind car crime and burglary. This highlights, surely, that previous public awareness campaigns have not been successful.

The successful intervention of health and social care agencies is fundamental to the government's agenda to tackle domestic violence. With this in mind, we also surveyed 40 social services and health managers, along with medical directors from hospitals and primary care trusts. We asked about their organisations' policies for defining, identifying and tackling domestic violence; the existence of protocols for routine screening of all service users, where women are asked if they have experienced domestic violence; and organisations' training and awareness of specialist resources. The results from the third that replied suggest that most agencies do have policies and procedures in place and some, such as accident and emergency departments, operate universal screening procedures on all women service users.

But what of frontline health and social care workers, whose vigilance and support can make all the difference to women's safety? Some 183 social workers, 165 midwives, 84 health visitors, 110 GPs and 34 accident and emergency staff returned our third set of questionnaires. Most were able to describe in broad terms the kinds of behaviours that constituted domestic abuse. However, most considered that they rarely encountered domestic violence in their practice. Where, then, are all the women who have experienced domestic abuse?

Reluctance to pry

Survey respondents admitted their reluctance to "pry". Despite their agencies' policies, they were confused about what to do if they did suspect domestic abuse. They were unaware of what support to expect if they took action to help an abused woman. Some frontline workers acknowledged a fear of embarrassment should they mistakenly suggest domestic abuse. Many were unaware of existing agency screening procedures.

These results point to a "practice vacuum", which may account for the low incidence of detected cases. After receiving the questionnaire, several respondents sought out the policies and procedures of which they had hitherto been unaware.

We interviewed 17 of the professional respondents after the survey. They revealed varied attitudes to the causes of domestic violence. One male GP believed that couples "might still love each other in spite of the abuse". A female social worker asserted that men perpetrate this kind of violence "to do something to orchestrate their power or get their identity back" following unemployment or poverty. Another female social worker concurred that men might "feel threatened by certain things" which might lead them to violence.

The study demonstrated that training for frontline workers is important, but that the sheer range of issues they face in their work means it has been a low priority for them and their employers.

The accounts of women we interviewed who were seeking help with domestic violence issues underscored the frontline workers' dilemmas. The women said they experienced many pitfalls, particularly the lack of "joined up" services. Telling a family doctor about the abuse, for example, did not automatically precipitate follow-up support from social workers or health visitors.

This is disturbing because disclosing violence demands courage from victims to overcome the real fear of reprisals. Another genuine worry was that social services could take victims' children into care. Anna Gupta, lecturer in child care social work at Royal Holloway, University of London knows from her own research that every case of domestic violence is different. She believes that the government should consider less formal family and community provision in its support of domestic violence victims, exercising every caution before social services consider taking children into care.

While domestic violence does cross the social spectrum, some women are especially vulnerable. Some 23% of women interviewed who had had more than one abusive partner also had parents and grandparents who had suffered or perpetrated domestic violence.

Abusive relationships do not end with the woman taking refuge. Women do return to their abusers, sometimes voluntarily, sometimes because their hiding place is discovered. Returning "home" for whatever reason has in cases led to further abuse, or even to murder.

Considering the Dash findings, what can the government do to stop domestic violence and to protect its victims?

It should begin by targeting public awareness campaigns at men. Frontline workers must be included in the planning and delivery of policy and training. Routine screening would involve putting open-ended, non-judgmental questions in a relaxed, private environment, to all female service users without their partners present, informing them of the high overall incidence of domestic violence, and making it clear that everyone is being asked the same questions. This screeing should be undertaken by frontline workers, particularly during and after pregnancy, when domestic violence can begin or is exacerbated. This might go some way to shrinking the shocking statistics of domestic violence in Britain.

· Paula Nicolson, author of the Dash report, became head of the department of health and social care at Royal Holloway, University of London in 2005. She conducted the research while she was professor of health psychology at Sheffield University. To order copies of the Dash report, email Liz Hudson at L.Hudson@rhul.ac.uk.